General question about second opinions

I think he's assuming it's like a mechanic checking a car who may claim you need a transmission when you do not. In that scenario, if you tell the mechanic ahead of time you're going to get a second opinion to verify, maybe you mitigate the risk of the scam recommendation.

Not sure doctors would have the same self-interest in erroneous diagnoses.

Fair point. Gotta love the US medical system.

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Is it better to let the doctor know up front you are getting a second opinion or should you let him diagnose you as normal and only say something once he advises a treatment plan?

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Probably depends on the issue. If it's something that already in the process of being worked up (imaging, studies, trials of certain therapy), it's nice to know what has and hasn't been done ahead of time. It's a little bit a nuisance and waste of time if you tell your whole story but leave out everything that's already been tried or done. Or if you surprise me at the visit with all the reports and imaging...then people wonder why 15 min visit turns into 45 mins

I get second opinions all the time, and it doesn't really change my management. I won't agree with another doctor just because.

Depends on the specialty. Just as a point of reference, orthopedic physicians in regards to an injury or arthritis will want xrays or mri after an initial exam to come up with a treatment plan. If you already have one opinion then you have already paid for that MRI/xray so if you want to pay for a second mri and set of films just to see if he agrees or disagrees with the initial physician, then go ahead and spend that money. In other words, don’t bullshite the physician. Tell them up front. They are all knowledgeable of each other’s work and they know who does and who doesn’t provide quality patient care.